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[The intermittent "warm" blood cardioplegia]
D Doyle1, F Dagenais, N Poirier
1Service de Chirurgie Cardiovasculaire et Thoracique, Hôpital Notre-Dame, Montréal, Québec, Canada.
Insights
Normothermic blood cardioplegia (NBC) is an effective and safe alternative for coronary bypass surgery. This method reduces oxygen demand and shows comparable outcomes to cold cardioplegia, with lower rates of inotropic drug and pacemaker use.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Context:
- Numerous cardioplegic solutions are currently used in clinical practice.
- Coronary artery bypass grafting (CABG) requires effective myocardial protection during surgery.
- Comparing different cardioplegia strategies is crucial for optimizing patient outcomes.
Purpose:
- To evaluate the efficacy and safety of intermittent normothermic (37°C) blood cardioplegia (NBC) in coronary bypass procedures.
- To compare NBC with cold crystalloid cardioplegia (CCC) and cold blood cardioplegia (CBC).
- To assess the impact of NBC on myocardial oxygen demand and clinical outcomes.
Summary:
- A study compared 66 patients receiving NBC with historical groups receiving CCC (68 patients) and CBC (41 patients).
- Patient demographics and preoperative conditions were comparable across all groups.
- NBC demonstrated reduced preoperative use of inotropic drugs and pacemakers, with similar rates of myocardial infarction and mortality compared to cold cardioplegia methods.
Impact:
- Normothermic blood cardioplegia is efficient in reducing myocardial oxygen demand through electromechanical arrest.
- Intermittent normothermic blood cardioplegia presents a safe and effective alternative for myocardial protection during cardiac surgery.
- Findings suggest NBC may lead to improved patient recovery and reduced perioperative complications.
Abstract:
Even today, a plethora of cardioplegic solutions are in clinical use. In the study presented here, sixty-six consecutive coronary bypass procedures received normothermic (37 degrees C) blood cardioplegia (NBC) intermittently. This group of patients was compared to an historical group of 68 patients having received cold crystalloid cardioplegia (CCC), and a second group of 41 patients having received cold blood (10 degrees C) cardioplegia (CBC). The number of patients, as well as their age, sex, functional class, ejection fraction and urgency of intervention were comparable between the three groups. The preoperative use of inotropic drugs was less prevalent in the normothermic blood cardioplegia group (NBC 24% v. CCC 52% and CBC 51%, p < 0.05), as was the use of a pacemaker (NBC 8% v. CCC 52% and CBC 51%, p < 0.02). Finally, the rates of myocardial infarction and mortality were comparable between the three groups. These results suggest that normothermic blood cardioplegia is efficient in reducing the demand in O2, by inducing the electromechanical arrest of the heart and, that intermittent normothermic blood cardioplegia can be safe and effective.